Pregnancy and giving birth after a caesarean section
Getting pregnant after a c-section
It usually takes longer to recover from a c-section than a vaginal birth, even if the birth was straightforward. It’s important to give your body time to recover before you start trying to get pregnant again. You will need to wait at least 6 months but your doctor or midwife may advise you to wait for 12–18 months. The longer you leave your scar to heal, the stronger it will be.
It’s particularly important to make sure your scar has completely healed if you want to try for a vaginal birth next time. This is because it is possible that the scar may open slightly. This is known as uterine dehiscence. It may not cause any serious issues, but it may increase the chance of a uterine rupture (a tear in the wall of the uterus), which can cause serious problems for both the mum and baby. The chances of a uterine rupture is higher if you have a vaginal birth next time, but it is still rare.
It may help to think about how long it took you to recover after your last c-section, your current physical health now and if you’re feeling emotionally ready. There are lots of positive things you can do to prepare for a healthy pregnancy and baby. Find out more about planning a pregnancy.
Of course, pregnancy isn’t always planned. Or you may want to get pregnant sooner for your own reasons. If you have become pregnant within a year of having a c-section, you may still be able to give birth vaginally if you want to. Your doctor or midwife will explain your best options for giving birth.
Birth options after a c-section
If you’ve had a c-section before, you can have a vaginal birth after a c-section (VBAC) or an elective repeat c-section (ERCS). If you are fit and healthy, both are safe choices with very small risks.
Your midwife or obstetrician will talk to you about your birth options soon after your fetal anomaly scan at 18–21 weeks. An obstetrician is a doctor who specialises in care during pregnancy, labour and after birth.
They can help you decide how to give birth by talking to you about:
- why you had a c-section last time
- whether you have had a vaginal birth
- any complications during your last c-section or during your recovery
- the type of cut that was made in your womb – horizontal or vertical
- how you feel about your most recent birth experience
- how your current pregnancy is progressing and if there have been any issues or complications
- how many more babies you are hoping to have in the future – the risks increase with each c-section, so you may want to avoid another c-section if possible.
If possible, you will need to decide what type of birth you would like before 36 weeks of pregnancy.
“I would say listen to your medical professionals and keep an open mind. I wanted a VBAC after a traumatic emergency c-section, several miscarriages and a difficult pregnancy. Unfortunately, this didn’t happen but my elective c-section was wonderfully civilised and a complete contrast to the first birth!”
Vaginal birth after a c-section (VBAC)
If you have only had one c-section before, you should be able to give birth vaginally if you’re carrying one baby and you go into labour after 37 weeks.
You’re more likely to have a successful vaginal birth if:
- you’ve had a vaginal birth before, especially if it was after a previous c-section
- labour starts naturally
- you were at a healthy weight when you got pregnant.
VBAC may not be suitable for you, for example, if you’re at risk of uterine rupture or there are problems with your baby’s health. Your doctor may advise you to have an elective repeat c-section (ERCS) instead.
“I had an emergency c-section with my first rainbow baby. When I fell pregnant with my second, I knew I wanted to try for a VBAC, but I had much more realistic expectations this time as it was a high-risk pregnancy. There was a moment during labour that I thought I would have another c-section, but thankfully I managed a vaginal birth. I did the same with my third and am hoping I can do it again with my fourth. I think every mum who has had a c-section should feel hopeful they can have a VBAC if that’s what they want, but be proud of themselves regardless.”
What are the advantages of a VBAC?
- If vaginal birth is successful, you’re less likely to have complications than if you have an elective repeat c-section (ERCS).
- Your recovery is likely to be quicker.
- Your stay in hospital may be shorter.
- You will avoid the risks of an operation.
- You’re more likely to have a successful vaginal birth in future pregnancies.
- Your baby will have less chance of breathing problems in the days after birth.
What are the disadvantages of a VBAC?
- On average, about 1 in 4 women will need an emergency c-section during labour. This carries a higher risk of complications than an elective repeat c-section (ERCS). For women who have had a vaginal birth before, about 1 in 10 will need an emergency c-section.
- There’s a higher chance of the scar in your womb tearing (uterine rupture). This happens in about 1 in 200 women. The chance of this happening is lower if you have had a vaginal birth before but it is more likely if your labour is induced (started artificially). If it looks like that may happen, you’ll be offered an emergency c-section.
- You have a slightly higher chance of needing a blood transfusion compared with women who choose a planned caesarean section.
- The risk to your baby of brain injury or stillbirth is higher than for a planned c-section, but is the same as if you were in labour for the first time.
"I had an emergency c-section with my first and desperately wanted a VBAC for my second. I went into labour naturally but did end up having a second emergency c-section. If we are lucky enough to have a third, it’s likely to be a planned c section and so I’m unlikely to ever experience vaginal birth. In the end, all that matters is that me and my baby are ok. Nothing about giving birth is easy so however I end up getting through it, I’ll be happy!"
Where can I give birth?
You may need to give birth in hospital, where you have quick access to more facilities if you need them. For example, in case you need an emergency c-section or a blood transfusion, or if your baby needs help to breathe.
This is especially important if you’re more likely to have complications, such as uterine rupture. This may be the case if your labour is induced or you have had more than one c-section before. Your doctor or midwife can help you decide what is best for you.
Can I have a vaginal birth if I have had more than one c-section?
If you have had more than one c-section, you should have the chance to talk to a senior obstetrician about the risks and benefits of a vaginal birth. Speak to your midwife as soon as possible to arrange a consultation with an obstetrician.
Going into labour before a VBAC
During your pregnancy, your doctor will explain what to do if you do or don’t go into labour before your VBAC. If you go into labour or your waters break, contact the hospital straight away. Once you start having regular contractions, the midwife will track your baby’s heartbeat.
You can choose your preferred type of pain relief during labour, including an epidural if you would like one.
If you don’t go into labour naturally by 41 weeks, your options may include:
- waiting for labour to start naturally
- inducing labour.
Inducing labour increases the chance of your previous c-section scar tearing, which could lead to you needing a c-section. The doctor and midwife will monitor you and your baby closely during labour. You can choose whether to have an induction or a c-section. Your doctor or midwife can explain the benefits and risks of both options to help you decide.
Elective repeat c-section (ERCS)
If you choose to have another c-section, you will usually have it after 39 weeks of pregnancy. Your obstetrician may suggest you have another c-section if you have:
- a vertical scar in your womb
- placenta praevia
- had a uterine rupture
- had uterine surgery.
What are the advantages and disadvantages of an ERCS?
Advantages of another c-section include:
- There’s a smaller risk of the c-section scar separating or tearing (1 in 1000).
- You will know the date of planned birth. But you may go into labour before this date or your healthcare team may need to change the date.
- The risk to your baby of brain injury or stillbirth is lower than for VBAC.
Disadvantages of an ERCS include:
- A repeat c-section usually takes longer than the first operation. This is because you will have scar tissue, which can make the operation more difficult. Scar tissue might also damage your bowel or bladder.
- You have a slightly higher risk of placenta praevia and/or placenta accreta in future pregnancies.
- You’re more likely to need a c-section in future pregnancies.
- Your baby has a slightly higher risk of breathing problems after birth if you have an ERCS before 39 weeks – you may have steroid injections before the birth to reduce this risk.
Read more about the benefits and risks of having a c-section.
What happens if I have an elective c-section planned but I go into labour?
Your doctor or midwife will help you plan what will happen if you go into labour before your elective c-section.
Tell your maternity team straight away if you start going into labour. They will help you decide on the safest option for you and your baby. This may be an emergency c-section, or if labour is very advanced it may be safer for you to have a vaginal birth.
Ask lots of questions so you have the information you need to make the right choice for you and your baby.
- Dodd JM et al. (2017) Elective repeat caesarean section versus induction of labour for women with a previous caesarean birth. Cochrane Database of Systematic Reviews Issue 7. Art. No.: CD004906. DOI: 10.1002/14651858.
- NHS. Planning another pregnancy. www.nhs.uk/pregnancy/trying-for-a-baby/planning-another-pregnancy/ (Page last reviewed: 13/07/2020. Next review due: 13/07/2023)
- NICE (2021). Caesarean birth: NICE guideline 192. National Institute for Health and Care Excellence www.nice.org.uk/guidance/ng192
- Royal College of Obstetricians & Gynaecologists (2015) Birth After Previous Caesarean Birth. Green-top Guideline No.45 www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg45/
- Royal College of Obstetricians and Gynaecologists 2016) Birth options after previous caesarean section. www.rcog.org.uk/en/patients/patient-leaflets/birth-after-previous-caesarean/
- Ye L et al (2019) Systematic review of the effects of birth spacing after cesarean delivery on maternal and perinatal outcomes. Int J Gynaecol Obstet. 2019; 147(1): 19-28.